Thaxton, Albert George 13�
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Albert George Thaxton Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/26/2023 71 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Pending
II] Accident Homicide Suicide Undetermined ❑
W Circumstances Investigation
U
W Medical Certifier Name Title
CI Nicole Warren NP
Address
9 Carey Road,Queensbury Town, New York 12804
Death Certificate Filed City Of Glens Falls District Number`' Register Number
City,Town or Village 5601 59
Burial Date Cemetery,Crematory or Facility Name
02/07/2023 Pine View Crematorium
• Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
- and/or and/or Held
- Hold Address
0
d Date Point of
(/)OTransportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street, P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/30/2023 Registrar of Vital Statistics )Megan Noliin(ECectronicaCCySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 2 J8113 Place of Disposition -1;w(L I_�-
LtJ
2 (address)
W
Cl) (section) (lot number) (grave number)
Name of.Sexton or Person in Charge of Pr ises h.. �" if
(pease print)
W pQ
Signature Title r�FM p
DOH-355(o7/18)p t of 2
F"68
Public Health Law Sec. 4145(2b) '-
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#